After (literally) hundreds of comments voicing concern that veterans would lose healthcare and benefits due to the Heritage Foundations’ Project 2025, we decided to jump into the 922-page conservative manifesto and read through the sections about the Department of Veterans Affairs, benefits, and healthcare.
For those interested in following along, the Veterans Affairs (VA) section, Chapter 20, begins on page 641. Mr. Brooks Tucker authored the chapter, and given how small of a community it is, we know Brooks personally and can speak to his dedication toward the veteran community. Brooks was appointed Acting Chief of Staff of the Department of Veterans Affairs in April 2020. Before that, Books served on the Presidential Transition Team, working on Veterans’ policy development. Between 2010 and 2015, he served as the Senior Policy Advisor for Senate members and Deputy Staff Director for the Senate Veterans Affairs Committee. Lastly, Brooks retired from the United States Marine Corps as a LtCol., with several combat deployments to the Middle East, Pacific, and Africa. Despite knowing Mr. Tucker, we will be as unbiased as possible in the review of the section. Still, it is worth noting that Mr. Tucker utilizes the Veterans Affairs Medical Center (VAMC) and speaks from professional and personal experience.
The report mentions that with the declining older veteran population and the lack of ongoing enrollment of post-9/11 era veterans, the VA is facing an overwhelming abundance in the workforce on the Veterans Health Administration (VHA) side. At the same time, implementations like the PACT Act require more manpower on the Veterans Benefits Administration (VBA) side (as compensation and disability benefits are continuously doubled that of health care expenditures). The lack of technology and innovation leads to significant delays in claims processing and medical records modernization, despite the VA paying Oracle-Cerner (on average) $100 million per month and approximately $50 billion over another six years to implement the system (yikes) ultimately. The review then breaks down the various areas of the VA – VHA and VBA and points out places that require reform, budget, and personnel.
VETERANS HEALTH ADMINISTRATION (VHA):
In theory, one reason why the VA spends twice as much on disability and compensation as compared to actual healthcare is the gap in generations. Aging older veterans are more likely to utilize the VHA for a majority of their care, while they are less likely to have disability benefits. In comparison, less than 30% of post-9/11 era veterans have enrolled or receive ongoing care within the VHA but are more likely to receive disability benefits and compensation. There are many reasons for this, the first being that the care lacks generational understanding. Below is what the Project2025 document states needs reform.
VHA NEEDS REFORM:
- Rescind and remove all clinical policy directives that do not align with service-connected conditions that would warrant VA providing clinical care for (specifically) abortion services and gender reassignment surgery.
- Prepare for a “generational shift” in age to appropriately care for increasing rates of younger veterans, as historically; the VHA has focused on chronic medical conditions commonly seen in an older population.
- Carry out the law of President Trump’s VA MISSION Act of 2018 as written, following timely, streamlined processing for veterans to access community care, if any of the following are true:
- Veterans need a service that is not available within VHA.
- Veteran lives in an area without full-service VAMC (AK, HI, NH, Guam, American Samoa, USVI, Mariana Islands)
- Veteran drives 30+ min. for Primary or Mental Health care
- Veteran drives 60+ min. for Specialized Care
- Veteran has wait time of 20+ days for Primary or Mental Health care
- Veteran has wait time of 28+ days for Specialized Care
- It is in the best medical interest of the veteran.
VHA BUDGET:
- Conduct independent audits to identify deficiencies within VHA – this is a transparency mechanism similar to that used in the nonprofit space.
- Assess the misalignment of VHA facilities. Many of the locations are underutilized and would be better served elsewhere nationwide. For example, Massachusetts has one of the lowest veteran percentages but numerous VHA facilities, whereas Montana has a larger veteran percentage with only one major VHA (see graphic below).
- Outdated medical equipment, technology, and facilities (some older than 60 years).
- Implement more widely community-based outpatient clinics (CBOCs), especially in rural areas.
- Require VHA to increase the number of patients seen daily to meet DOD standards. DOD currently sees approximately 19 patients/day per provider, whereas VHA may see as little as six patients/day per provider.
- Pilot a program extending hours on weekdays and Saturdays to meet the needs of younger aged veterans who work during normal VHA operational hours.
- Continue to leverage telehealth as needed/requested by Veterans.
- Consider expanding VA tuition assistance to providers in exchange for reciprocal services in rural or understaffed areas.
VETERANS BENEFITS ADMINISTRATION (VBA):
The current benefits process is complex and confusing, unclear and drawn out, which leads to long-term distrust and hatred toward the VA. Additionally, while there is a “standard” rating system, many veterans with significant disabilities are left confused as while some may be approved, another veteran with the same condition is denied.
VBA NEEDS REFORM:
- The most pronounced example of this problem is the disability claims process, which lacks streamlined decision-making and timeliness. Just recently, we met a veteran who is seven years into his claim and hearing process. Project2025 suggestions for change:
- “Express 30” – a pilot that commits to having a first-time fully developed claim (FDC) decision to veterans within 30 days of applying.
- Hire more private companies (such as QTC, etc.) to perform disability medical exams and curb delays in wait times. We (H7F) are concerned that many of these contractors lack guidelines and understanding of veterans, as noted in our recent publication.
- Increased automation to prevent human error and hiring additional staff to process claims are costly, inflexible, and yield mixed results.
- Reduce fraud and improper payment, as $500 million is paid out each year improperly (no other context was given).
VBA BUDGET:
- Many conditions have been inappropriately labeled or assigned a disability rating concerning service while, in actuality, they are not; for example, the PACT Act implemented hypertension and diabetes as a result of military service in Vietnam; however, statistically speaking, that is incorrect and unlikely to be related. Contrarily, cancers like Leukemia, notoriously related to carcinogenic exposures, are not considered a presumptive condition amongst post-9/11 veterans.
- Suggests the incoming administration explore how VASRD (VA’s Schedule for Rating Disabilities) could be accelerated with clearance from OMB to revise disability award scheduling for future claimants while preserving them fully or partially for existing claimants.
- This goes many ways, the first being that if a veteran is granted service connection for cancer, they receive “temporary” disability at 100% until they complete treatment, in which they are re-evaluated, and often their rating for that cancer decreases to 0%. However, this doesn’t consider the ill effects of treatment, chemotherapies, and secondary conditions.
HUMAN RESOURCES AND ADMINISTRATION (HRA)
Project2025 in relation to Veterans Affairs focuses heavily on implementing leaders who are forward-thinkers, not career politicians. Stated, “Senior executives and leadership need more innovators and trailblazers – qualities that have sometimes been lacking in the VBA’s senior ranks.” The proposal also questions the lack of in-person work days and the actual need for all of these excess individuals who are not needed, as many of those employed who are not required in the office could have employment funds reallocated to an area of more dire need. The report suggests taking a close and analytically critical look at where hybrid and remote work is a net positive as a functional necessity and where in-person collaboration and presence will help to instill a strong work ethic and a more cohesive environment for productivity from the Office of the Secretary across the headquarters enterprise and that The “remote work” expectation has been amplified and formalized within the Biden Administration team at VA to the extent that the current Secretary, Deputy Secretary, and their staffs are not “in office” as a matter of a routine presence while VA staff in Washington, D.C.
WHAT HUNTERSEVEN BELIEVES:
Bureaucratic inefficiencies driven by organizational politics have created a rigid structure that providers and patients find challenging to navigate. This structure slows decision-making and resource allocation, often prioritizing administrative requirements over patient-centered care. As a result, veterans experience long wait times and considerable barriers to accessing essential services, creating complications in the care continuum. Frequent provider turnover, primarily due to the VA’s massive educational infrastructure, disrupts continuity of care, preventing veterans from building rapport and establishing continued therapeutic relationships with their interdisciplinary care team members. This inconsistency contributes to missed diagnoses and fragmented care and lowers veteran utilization rates. Additionally, as a government-funded entity, even minor policy updates or system improvements within the VA require a lengthy approval process, often contingent on congressional approval, which delays significant and necessary changes. These challenges underscore the urgent need for systems issues assessments and structural reform to provide veterans with timely, consistent, high-quality care.
Political influences play a significant role in shaping decision-making within the VA, with shifting external pressures often driving new initiatives. Each election cycle brings new directives and priorities, resulting in inconsistencies that undermine stability in both policy and care practices. These frequent shifts disrupt the VA’s ability to maintain a coherent, long-term strategy for veteran care, forcing the VA (and providers) to adapt to continuous external pressure rather than focus on sustainable improvements for veterans’ health outcomes.
In contrast to the civilian population, post-9/11 military veterans are being diagnosed with cancer at much younger ages, often in their 30s and 40s. These veterans have been exposed to various environmental hazards and physical and psychological stressors during their service (Waszak & Holmes, 2017). These unique risk factors increase their vulnerability to cancers that typically emerge later in life. The early onset of cancer in military service members and veterans not only disrupts their lives but also places an additional strain on the government, healthcare systems, and national security. Furthermore, post-9/11 military veterans are at risk for anchoring biases when presenting with medical concerns. Despite being considered an exceptionally fit population, the potential for overlooked health issues is significant due to the prevalence of psychological stress and trauma within this group. This bias may lead to delayed diagnoses, particularly for conditions like cancer, as healthcare providers may attribute symptoms to stress-related disorders rather than considering more serious underlying conditions.
The financial implications of this problem are substantial. The cost of treating late-stage cancers is high. When coupled with the expenses related to presumptive disability and death benefits for post-9/11 veterans and their surviving families, it becomes a significant burden and a loss of life that could have very well been prevented. Before change can be implemented, it is vital to understand the burden cancer has on the post-9/11 veteran population when compared to their non-military, civilian counterpart. By identifying clinical gaps, analyzing population trends, and evaluating outcomes, healthcare systems can focus on early identification and risk reduction strategies. This, in turn, can lead to financial savings and, most importantly, improved health outcomes for veterans placed at an increased risk.
We do believe the items related to healthcare and the need to improve clinical practice guidelines are mission-essential. Still, we do not think the VHA has the construct or capacity to do this largely based on political limitations. We utilize the VHA for care as it is convenient and local, while others on our team do not. However, we believe veterans should have a say in how, where, why, and when they receive care. We’ll never let this video go; former Sen. Tester really did a disservice to veterans.
